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1.
Cir Esp (Engl Ed) ; 101 Suppl 4: S43-S51, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37979942

ABSTRACT

Sleeve gastrectomy (SG) is the most common bariatric surgery worldwide and has shown to cause de novo or worsen symptoms of gastroesophageal reflux disease (GERD). Esophageal motility and physiology studies are mandatory in bariatric and foregut centers. The predisposing factors in post-SG patients are disruption of His angle, resection of gastric fold and gastric fundus, increased gastric pressure, resection of the gastric antrum, cutting of the sling fibers and pyloric spasm. There are symptomatic complications due to sleeve morphology as torsion, incisura angularis stenosis, kinking and dilated fundus. In this article, we present recommendations, surgical technique and patient selection flow diagram for SG and avoid de novo or worsening GERD.


Subject(s)
Bariatric Surgery , Gastroesophageal Reflux , Obesity, Morbid , Humans , Obesity, Morbid/surgery , Obesity, Morbid/complications , Gastroesophageal Reflux/diagnosis , Gastrectomy/adverse effects , Gastrectomy/methods , Stomach , Bariatric Surgery/adverse effects , Bariatric Surgery/methods
2.
Rev Gastroenterol Peru ; 41(1): 48-51, 2021.
Article in English | MEDLINE | ID: mdl-34347772

ABSTRACT

Portal vein thrombosis (PVT) is a rare condition in the general population that develops serious complications if left untreated for long time. We present a case of a 29-year-old woman who developed PVT due to protein S deficiency versus neonatal funiculitis. Over time, the patient developed upper gastrointestinal bleeding due to esophageal varices and hypersplenism with splenic sequestration that caused minor bleeding episodes. Laparoscopic splenectomy and proximal splenorenal shunt with distal pancreatectomy due to aneurysmal dilatations of the splenic artery were successfully performed to avoid mayor progression of portal hypertension. Patient was discharged with indefinite anticoagulation and after surgery platelets raised up to 200x103/mm3. Laparoscopic splenectomy and proximal splenorenal shunt for portal hypertension due to portal vein thrombosis is an adequate surgery procedure which should be applied in these medical cases.


Subject(s)
Esophageal and Gastric Varices , Hypertension, Portal , Laparoscopy , Protein S Deficiency , Splenorenal Shunt, Surgical , Venous Thrombosis , Adult , Female , Gastrointestinal Hemorrhage , Humans , Hypertension, Portal/complications , Infant, Newborn , Portal Vein/surgery , Splenectomy , Venous Thrombosis/complications , Venous Thrombosis/surgery
3.
Rev. gastroenterol. Perú ; 41(1)ene. 2021.
Article in English | LILACS-Express | LILACS | ID: biblio-1508570

ABSTRACT

Portal vein thrombosis (PVT) is a rare condition in the general population that develops serious complications if left untreated for long time. We present a case of a 29-year-old woman who developed PVT due to protein S deficiency versus neonatal funiculitis. Over time, the patient developed upper gastrointestinal bleeding due to esophageal varices and hypersplenism with splenic sequestration that caused minor bleeding episodes. Laparoscopic splenectomy and proximal splenorenal shunt with distal pancreatectomy due to aneurysmal dilatations of the splenic artery were successfully performed to avoid mayor progression of portal hypertension. Patient was discharged with indefinite anticoagulation and after surgery platelets raised up to 200x103/mm3. Laparoscopic splenectomy and proximal splenorenal shunt for portal hypertension due to portal vein thrombosis is an adequate surgery procedure which should be applied in these medical cases.


La trombosis de la vena porta (TVP) es una afección poco común en la población general que desarrolla complicaciones graves si no se trata durante mucho tiempo. Presentamos el caso de una mujer de 29 años que desarrolló TVP por deficiencia de proteína S versus funiculitis neonatal. Con el tiempo, la paciente desarrolló hemorragia digestiva alta por varices esofágicas e hiperesplenismo con secuestro esplénico que provocó episodios hemorrágicos menores. La esplenectomía laparoscópica y la derivación esplenorrenal proximal con pancreatectomía distal por dilataciones aneurismáticas de la arteria esplénica se realizaron con éxito para evitar una mayor progresión de la hipertensión portal. La paciente fue dada de alta con anticoagulación indefinida y tras la cirugía se elevaron las plaquetas hasta 200x103/mm3. La esplenectomía laparoscópica y la derivación esplenorrenal proximal para la hipertensión portal por trombosis de la vena porta es un procedimiento quirúrgico adecuado que debe aplicarse en estos casos médicos.

4.
Rev Gastroenterol Peru ; 39(1): 12-20, 2019.
Article in Spanish | MEDLINE | ID: mdl-31042232

ABSTRACT

OBJECTIVES: Establish the prevalence of gastric polyps detected by upper gastrointestinal endoscopy in patients older than 18 years old during the period from 2007 - 2016 in Cayetano Heredia Hospital. MATERIALS AND METHODS: Retrospective cross-sectional study, performed with data from the gastric biopsies reports of patients that have undergone upper gastrointestinal endoscopy between January 2007 and July 2016. Demographic data, endoscopic characteristics of the polyps and associated histological changes of the surrounding gastric mucosa were evaluated, which were subjected to statistical analysis using STATA v14.2. RESULTS: In a population of 16 552 endoscopies, 407 gastric polyps biopsies were found. These results give a prevalence of 2.5% .Gastric polyps were detected predominantly in women (62.38%). The median age was 61 years (52-71 years). The most frequent histological type was the fundic gland polyp (FGP) (44.85%), followed by the hyperplastic (38.48%) and adenomatous (15.23%) polyp. The most frequent location was in the fundus / corpus (48.65%, p = 0.001). The presence of Hp was detected in 30.6% of the biopsies with polyps. CONCLUSION: The prevalence of gastric polyps is similar to other regions of the world; PGF and hyperplastic are the most frequent. Adenomatous polyps showed a greater relationship with and metaplasia and dysplasia.


Subject(s)
Adenomatous Polyps/epidemiology , Stomach Neoplasms/epidemiology , Adenomatous Polyps/classification , Adenomatous Polyps/pathology , Aged , Biopsy , Cross-Sectional Studies , Female , Gastric Mucosa/pathology , Gastritis/epidemiology , Gastritis/pathology , Gastroscopy , Helicobacter Infections/epidemiology , Helicobacter Infections/pathology , Helicobacter pylori/isolation & purification , Hospitals, Public/statistics & numerical data , Hospitals, Urban/statistics & numerical data , Humans , Hyperplasia , Inflammation , Male , Metaplasia , Middle Aged , Peru/epidemiology , Prevalence , Retrospective Studies , Stomach Neoplasms/classification , Stomach Neoplasms/pathology
5.
Rev. gastroenterol. Perú ; 39(1): 12-20, ene.-mar. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1014121

ABSTRACT

Objetivos: Determinar la prevalencia de pólipos gástricos detectados mediante endoscopía digestiva alta, en pacientes mayores de 18 años del Hospital Cayetano Heredia, en el periodo 2007-2016. Materiales y métodos: Estudio retrospectivo de corte transversal, realizado con datos de biopsias gástricas de pacientes sometidos a endoscopía digestiva alta entre enero de 2007 y julio de 2016. Se evaluó cambios histológicos asociados, datos demográficos y características endoscópicas, las cuales fueron sometidas a análisis estadístico mediante STATA v14.2. Resultados: En una población de 16 552 endoscopías realizadas, se encontró 407 biopsias compatibles con pólipos gástricos, lo cual da una prevalencia de 2,5%. Los pólipos gástricos fueron más frecuentes en mujeres (62,38%). La mediana de edad fue de 61 años (52-71 años). El tipo histológico más frecuente fue el pólipo glandular fúndico (PGF) (44,85%), seguido de pólipo hiperplásico (38,48%) y adenomatoso (15,23%). La localización más frecuente fue en fondo/cuerpo (48,65%, p=0,001) Se detectó la presencia de Helicobacter pylori (Hp) en el 30,6% de las biopsias compatibles con pólipos. Conclusión: La prevalencia de pólipos gástricos es similar con otras regiones del mundo; los PGF e hiperplásicos son los más frecuentes. Los pólipos adenomatosos estuvieron en mayor relación a cambios como metaplasia y displasia.


Objectives: Establish the prevalence of gastric polyps detected by upper gastrointestinal endoscopy in patients older than 18 years old during the period from 2007 - 2016 in Cayetano Heredia Hospital. Materials and methods: Retrospective cross- sectional study, performed with data from the gastric biopsies reports of patients that have undergone upper gastrointestinal endoscopy between January 2007 and July 2016. Demographic data, endoscopic characteristics of the polyps and associated histological changes of the surrounding gastric mucosa were evaluated, which were subjected to statistical analysis using STATA v14.2. Results: In a population of 16 552 endoscopies, 407 gastric polyps biopsies were found. These results give a prevalence of 2.5% .Gastric polyps were detected predominantly in women (62.38%). The median age was 61 years (52-71 years). The most frequent histological type was the fundic gland polyp (FGP) (44.85%), followed by the hyperplastic (38.48%) and adenomatous (15.23%) polyp. The most frequent location was in the fundus / corpus (48.65%, p = 0.001). The presence of Hp was detected in 30.6% of the biopsies with polyps. Conclusion: The prevalence of gastric polyps is similar to other regions of the world; PGF and hyperplastic are the most frequent. Adenomatous polyps showed a greater relationship with and metaplasia and dysplasia.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Stomach Neoplasms/epidemiology , Adenomatous Polyps/epidemiology , Peru/epidemiology , Stomach Neoplasms/classification , Stomach Neoplasms/pathology , Biopsy , Hospitals, Urban/statistics & numerical data , Prevalence , Cross-Sectional Studies , Retrospective Studies , Helicobacter pylori/isolation & purification , Helicobacter Infections/pathology , Helicobacter Infections/epidemiology , Gastroscopy , Adenomatous Polyps/classification , Adenomatous Polyps/pathology , Gastric Mucosa/pathology , Gastritis/pathology , Gastritis/epidemiology , Hospitals, Public/statistics & numerical data , Hyperplasia , Inflammation , Metaplasia
6.
Injury ; 48(9): 1985-1993, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28476355

ABSTRACT

INTRODUCTION: Trauma quality improvement (QI) programs have been shown to improve outcomes and decrease cost. These are high priorities in low- and middle-income countries (LMICs), where 2,000,000 deaths due to survivable injuries occur each year. We sought to define areas for improvement in trauma QI programs in four LMICs. METHODS: We conducted a survey among trauma care providers in four Andean middle-income countries: Bolivia, Colombia, Ecuador, and Peru. RESULTS: 336 physicians, medical students, nurses, administrators and paramedical professionals responded to the cross-sectional survey with a response rate greater than 90% in all included countries except Bolivia, where the response rate was 14%. Eighty-seven percent of respondents reported morbidity and mortality (M&M) conferences occur at their hospital. Conferences were often reported as infrequent - 45% occurred less than every three months and poorly attended - 63% had five or fewer staff physicians present. Only 23% of conferences had standardized selection criteria, most lacked documentation - notes were taken at only 35% of conferences. Importantly, only 13% of participants indicated that discussions were routinely followed-up with any sort of corrective action. Multivariable analysis revealed the presence of standardized case selection criteria (OR 3.48, 95% CI 1.16-10.46), written documentation of the M&M conferences (OR 5.73, 95% CI 1.73-19.06), and a clear plan for follow-up (OR 4.80, 95% CI 1.59-14.50) to be associated with effective M&M conferences. Twenty-two percent of respondents worked at hospitals with a trauma registry. Fifty-two percent worked at institutions where autopsies were conducted, but only 32% of those reported the autopsy results to ever be used to improve hospital practice. CONCLUSIONS: M&M conferences are frequently practiced in the Andean region of Latin America but often lack methodologic rigor and thus effectiveness. Next steps in the maturation of QI programs include optimizing use of data from autopsies and registries, and systematic follow-up of M&M conferences with corrective action to ensure that these activities result in appreciable changes in clinical care.


Subject(s)
Quality Improvement/organization & administration , Trauma Centers/organization & administration , Trauma Centers/standards , Bolivia/epidemiology , Colombia/epidemiology , Cost-Benefit Analysis , Cross-Sectional Studies , Ecuador/epidemiology , Humans , Peru/epidemiology , Process Assessment, Health Care , Program Development , Wounds and Injuries/therapy
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